Stereotactic gamma knife radiosurgery for brain arteriovenous malformations (A Report of 216 Cases)

LIANG Jun-chao; XU Bo-tao; WANG Wei-min; ZHAO Gang; WU Hong-xun; LI Lin; HE Dao-hua; ZHANG Yu-hao

doi:10.3969/j.issn.1009-6574.2007.02.006

Abstract：Objective To evaluate the curative effect of stereotactic gamma knife radiosurgery on brain arteriovenous malformations (AVM).Methods Between July 1995 and May 1998,285 patients with cerebral AVM were treated with Leksell gamma knife,among which we collected the follow-up files of 216 cases fitting our demand,including 162 male and 54 female patients.The mean age of patients was 26.0 years (1.5～83 years).AVM volume ranged from 0.3 to 43.9 cm3 (the mean volume of Spetzler-Martin grading were as follows:grade I 42 cases,grade Ⅱ 68 cases,grade Ⅲ 95 cases,grade Ⅳ 7 cases,grade Ⅴ 4 cases.All the cases were followed up for 17～31 months.156 cases were oriented through conducting magnetic resonance angiography (MRA) with a 1.5 Tesla magnetic resonance system.Results The rates of obliteration and complications after stereotactic gamma knife radiosurgery were significantly related to the target volume,the Spetzlcr-Martin grade,the method of localization,the peripheral dosage and the quality control.The obliteration rate within two years was more than 78.5% in the patients with AVM≤5 cm3 in volume,Spetzler-Martin grade＜Ⅲ in Spetzler-Martin grading system or peripheral dosage≥20Gy.4 cases had recurrent hemorrhage after the treatment and 9 cases had complications of obvious symptom of irradiated brain edema.Conclusions Stereotactic gamma knife radiosurgery is an effective and safe method for the brain AVM.There is a higher obliteration rate for AVM of grade Ⅰ-Ⅱ or the volume≤5.0 cm3 and the peripheral dosage≥20Gy.Accurate localization of the lesions by magnetic resonance angiography (MRA) combined with digital subtraction angiography (DSA) contributes to improve the obliteration rate and decrease the complications.